Provider Demographics
NPI:1477648178
Name:IRON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:IRON COUNTY HOSPITAL DISTRICT
Other - Org Name:IRON COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-546-8051
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:301 NORTH HWY 21
Mailing Address - City:PILOT KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:63663
Mailing Address - Country:US
Mailing Address - Phone:573-546-1260
Mailing Address - Fax:573-546-8088
Practice Address - Street 1:301 N HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663-0548
Practice Address - Country:US
Practice Address - Phone:573-546-1260
Practice Address - Fax:573-546-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO501-4282NC0060X, 282NC0060X
MO501-1282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO019899608Medicaid
MO26Z336Medicare Oscar/Certification
MO261336Medicare Oscar/Certification